Food Is Medicine

Judging by research released this month in the American Journal of Medicine and an article in TheAtlantic, people are catching on to the fact that access to good food can be a form of preventive medicine.

Nearly one in three U.S. adults with a chronic disease has problems paying for food, medicine, or both. Researchers at Harvard and the University of California at San Francisco studied data from the 2011 U.S. Centers for Disease Control's National Health Interview Survey, and of the 10,000 adults who reported that they had a chronic disease such as diabetes, asthma, arthritis, high blood pressure, stroke, a mental health problem, or chronic obstructive pulmonary disease, nearly one in five said they had problems affording food during the past 30 days, qualifying as "food insecure." Nearly one in four said they had skipped medication dosages because of cost. More than one in ten said they had problems paying for both food and medication. Among those whose illnesses were most diet-related, like diabetes and heart disease, individuals were particularly concerned with finding the right food needed to stay healthy.

Our foundation as New York City's leading provider of medically-tailored home delivered meals for men, women and children living with serious illnesses was built 29 years ago during the first years of the AIDS pandemic, delivering meals to clients to combat the wasting effects of the diagnosis. As the trajectory of the disease has changed, so has the way in which we deliver nutrition. At God's Love, we know firsthand what more and more research proves every day: food is medicine. When people living with HIV/AIDS (PLWHA) are food secure, they are more likely to take their medications, and keep doctors' appointments. They are more likely to have higher CD4 counts and undetectable viral loads, and are more likely to engage and remain in care.

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What is clear from all this is that PLWHA should not have to choose between food and medication if we are to attain our goal of an AIDS Free Generation. The Ryan White Program offers the most comprehensive package of food and nutrition support in the country, but it is still not enough. A recent longitudinal study of PLWHA in New York City demonstrated that 42% of PLWHA who were receiving food assistance were still food insecure.

The article in The Atlantic focuses on how Medicaid could help patients afford their medications and also suggests screening tools to help doctors connect patients to existing food programs, like SNAP (the Supplemental Nutrition Assistance Program, or food stamps). But other options go unmentioned. Food and nutrition services (FNS), especially medically tailored home-delivered meals for the most at-risk individuals, could be incorporated into medical care through coverage in private and public insurance, resulting in massive cost savings for providers, and better health outcomes for patients.

To put the cost savings in perspective, MANNA, our sister FNS agency in Philadelphia that delivers medically tailored home-delivered meals, recently mounted a rigorous pilot study matching MANNA clients to a control group within a local managed care organization to compare healthcare costs on and off the MANNA FNS program. The results were stunning. Average health care costs for MANNA clients fell 62% for three months after beginning services (for a total of almost $30,000). For PLWHA, the cost savings were even more dramatic, falling over 80% in the first three months.

Compared to medical care, food is cheap. You can feed a person a home-delivered diet tailored for their unique medical circumstances for $20 a day. Hospitalization can cost $4,000 a day. If food services prevent one day of hospitalization for a person with chronic illness, the medical cost savings would feed them for more than half a year. The impact of providing patients with the right food for their medical situations is undeniable, and yet, there remains great resistance to the concept of "food is medicine" in healthcare.

There are some positive signs. Progressive states, like New York and Maryland, have already incorporated FNS into the Medicaid benefits package for their most at-risk populations through federal waivers. Although FNS programs, like God's Love, are small relative to the need and are centered largely in urban areas, we are demonstrating successful outcomes. Our hope is that modeling cost-savings and positive health outcomes will encourage other states to follow suit. Until they do, some of the most vulnerable among us will be forced to choose between two forms of medicine.

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